In the past two decades, research has shown an increased risk of violence among patients with mental disorder. However, the underlying pathways have remained controversial, say the authors of a recent review of the literature from Montpellier, France (Département d’urgence et post-urgence psychiatrique, Hôpital Lapeyronie; Service universitaire de psychiatrie adulte, Hôpital La-Colombière).
Available literature displays violent behavior of mentally ill people as a heterogeneous phenomenon, possibly involving multiple inter-related factors. When assessing risk of dangerousness it is likely to place more focus on dynamic risk factors. Therefore, the authors focused on the association between insight and violent behaviors. This review included twenty studies that evaluated this association, considering violent behavior in terms of physical or verbal violence, aggressiveness, hostility, and sexual aggression.
The authors found that a greater cognitive insight may be associated with a lower incidence of violence, in particular in schizophrenia by decreasing the degree of confidence related to psychotic symptoms.
The authors stated that, despite some shortcomings (i.e., heterogeneity in the definition and assessment of violence; minority of prospective studies; lack of systematic consideration of possible confounding variables), available evidence suggests that it is important to identify a subgroup of patients at risk of violence and provide them with targeted treatment. These suggestions fit the growing efforts to reduce stigma associated with mental illness.
The article full text (in French) is available at:
Bonnet S, Lacambre M, Schandrin A, Capdevielle D, Courtet P. [Insight and psychiatric dangerousness: A review of the literature]. L’Encéphale. 2017;43(2):146-153. doi: 10.1016/j.encep.2016.01.010.
To find out more on insight and violent behavior also read “Insight and Violent Behavior in a Cohort of Early Psychosis” (2018;63:20-29) published in the Canadian Journal of Psychiatry (impact factor 3.612).